Psychology, Department of


First Advisor

William Spaulding

Date of this Version

Summer 6-25-2021


Fischer, S. (2021). Approaches for and Barriers to the Long-Term Execution of a Recovery-Oriented Rehabilitation Model of Treatment in a Community Day Psychiatric Rehabilitation Setting, [Doctoral Dissertation, University of Nebraska-Lincoln]. ProQuest Dissertations Publishing.


A DISSERTATION Presented to the Faculty of The Graduate College at the University of Nebraska In Partial Fulfillment of the Requirements For the Degree of Doctor of Philosophy, Major: Psychology, Under the Supervision of Professor William D. Spaulding. Lincoln, Nebraska: June 2021

Copyright © 2021 Sarah Fischer


This dissertation explores the process of creating, implementing, adapting and evaluating a program of care that is composed of specific program features that promote the acquisition of independent living skills, prosocial behavior, progress toward personal recovery goals, and more integrated community living. This program was created and implemented at a community mental health agency that provides integrated mental health care services for individuals with serious mental illness (SMI).

The goals of this dissertation were to (1) compare initial and long-term fidelity to the psychiatric rehabilitation model in order to establish the program’s ability to prevent drift, (2) explore the culture of the agency in order to examine the overall ability and commitment throughout all the programs to combating stigma and utilizing evidence-based practices, (3) evaluate the success of the program implementation and identify important factors for and barriers to implementation using Consolidated Framework for Implementation Research (CFIR), (4) analyze data from the consumer feedback surveys, and (5) create a list of recommendations for adapting the program manual for enhanced fidelity to the psychiatric rehabilitation model.

Staff understanding of and openness to using evidence-based practices as measured by the Evidence-Based Practice Attitudes Scale-36 (EBPAS-36) was strong across the agency. Scores were not influenced by the program staff belong to but were influenced by staff “level.” Provider-based stigma, measured using the Mental Health Provider-Based Self-Assessment of Stigma Scale-Refined (MHPBSASS-R), demonstrated a low-average level of provider-based stigma, with no group differences by program or staff level.

This dissertation found that the Program Manual and its associated program features were highly acceptable to staff and consumers and meets the needs of the program fairly well. However, there were several factors that hindered the implementation of the full program of care, and recommendations are made for improving model and intervention fidelity, including recommendations pertaining to the manual itself, the agency’s training approach, and specific program features to adapt or implement.

Advisor: William D. Spaulding